Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
Korean J Intern Med. 2022 May;37(3):591-604. doi: 10.3904/kjim.2021.539. Epub 2022 Apr 28.
BACKGROUND/AIMS: Acute myocardial infarction (AMI) is conventionally recognized as an urgent medical condition requiring timely and effective reperfusion therapy. However, the results of studies on the clinical outcomes in AMI according to hospital visit timings are inconclusive. To explore the difference in long-term outcomes between off- and on-hour percutaneous coronary interventions (PCI) in patients with AMI of Killip functional classification III-IV (Killip III-IV AMI).
Data on the characteristics and clinical outcomes of 1,751 patients with Killip III-IV AMI between November 2011 and June 2015 from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry were analyzed. All participants were allocated into two groups: off-hour (weekdays from 6:00 PM to 8:00 AM, weekends, and legal holidays) and on-hour (weekdays from 8:00 AM to 6:00 PM) groups. The incidence of major adverse cardiac and cerebrovascular events, defined as a composite of all-cause mortality, nonfatal myocardial infarction, any revascularization, cerebrovascular accident, and stent thrombosis, was the primary endpoint.
Among the 1,751 patients, 572 (39.1%) underwent PCI during on-hours and 892 (60.9%) during off-hours. At the 3-year follow-up, no significant difference was found in the clinical outcomes between the two groups in both the unadjusted and propensity-score weighing-adjusted analyses.
The outcomes of patients with Killip III-IV AMI admitted during off- and on-hours were similar.
背景/目的：急性心肌梗死（AMI）通常被认为是一种紧急医疗状况，需要及时有效的再灌注治疗。然而，关于根据就诊时间对 AMI 临床结局进行研究的结果尚无定论。本研究旨在探讨 Killip 心功能分级 III-IV（Killip III-IV AMI）的 AMI 患者行非高峰和高峰时间经皮冠状动脉介入治疗（PCI）的长期结局差异。
对 2011 年 11 月至 2015 年 6 月期间来自韩国急性心肌梗死注册-美国国立卫生研究院登记处的 1751 例 Killip III-IV AMI 患者的特征和临床结局数据进行分析。所有患者被分为两组：非高峰时间（工作日 6：00 PM 至 8：00 AM、周末和法定节假日）和高峰时间（工作日 8：00 AM 至 6：00 PM）。主要不良心脑血管事件（MACCE）发生率定义为全因死亡率、非致死性心肌梗死、任何血运重建、卒中和支架血栓形成的复合终点，是主要终点。
在 1751 例患者中，572 例（39.1%）在高峰时间行 PCI，892 例（60.9%）在非高峰时间行 PCI。在 3 年随访中，未校正和倾向评分加权校正分析均未发现两组之间的临床结局存在显著差异。
在非高峰和高峰时间入院的 Killip III-IV AMI 患者的结局相似。
